SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name
Safety– Pneumonia with IV issues Senior Level
Program/Curriculum Specific Objectives: Awareness of safety issues related to
patient identification and communication.
Measurable Objectives (minimum 2, maximum 10)
1. Identify IV fluids with wrong rate and solution (IV label belongs to a different
patient.
2. Identify IV site infiltration
3. Complete a SBAR handoff report
Instructor’s Name: Mary Burroughs Shoreline Community College
Karen Paulsen Northwest Hospital and Medical Center
Date Submitted Spring 2013
Will There Be Any Pre-Simulation Lecture?
No
Expected Scenario Time 15 minutes Expected Debrief Time
15 – 30 minutes
Report and Information Provided To Participants Prior To Simulation
It is shift change. The night shift nurse needs to give the day shift nurse report.
Samantha was admitted last night with left lower lobe pneumonia. She is receiving IV
antibiotics and IV fluids for dehydration. Her last vital signs were BP 112/64, HR 114,
RR 22, SpO2 94% on 4 liters per nasal cannula. She has decreased breath sounds in the
left lower lobe.
Patient Information
Patient Name:
Age: 64
Samantha Simman
Gender:
Birth date: March 11, 1949
Female
Height:
Weight:64 Kg
5’4”
ID band MR #00001234 Acct. # 1198765432
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
1
SIMULATION DESIGN & PLANNING TEMPLATE
Hx. Present Illness: Increased shortness of breath over the last week with a
productive cough.
Social History: Divorced school teacher, occasional ETOH beverage with
friends.
Religion: Jewish
Support System: Two children in the area, one dog Allergies: NKDA
Immunizations: Up to date, but never had a pneumonia vaccine.
Attending Physician: Dr. Peters
Past medical history: 1 PPD smoker since she was in high school, she wants to
try to quit. Physician has been monitoring her BP, has borderline hypertension
(144/86).
Physical description of how you want the manikin to present at start of scenario?
Left forearm IV site red, swollen, leaking
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Unlicensed Assistive Personnel/CNA/MA
Other: IV Nurse
Other: Night shift nurse
Important Information Related To Roles:
Night shift nurse: It has been a busy night and your patient has been sleeping on and
off. You gave her IV antibiotic at 0600 and you hung her second liter of IV fluids at
0400. Her last vital signs at 0400 were BP 112/64, HR 114, RR 22, Sp02 94% on 4
liters per nasal cannula. Her assessment was significant for decreased breath sounds in
the left lower lobe. Her chest w-ray showed left lower lobe pneumonia. Her cough has
been productive with green, thick, sticky secretions. She has a hard time coughing them
up, which leaves her tired and more short of breath. She has been getting up to the
bathroom with stand-by assist due to her IV pole and SCDs.
SIM Setup
Abrasion / Bruise
R / L forearm _red with
leaking IV
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
2
SIMULATION DESIGN & PLANNING TEMPLATE
Mannequin
IV site :
3G
Site left forearm Gauge 18
Fidelity (choose all that apply to this simulation)
Setting/Environment
Med-Surg
Props:
Equipment attached to manikin:
Primary IV Fluid running at 125 ml/hr
Secondary IV Fluid (Antibiotic) OFF – clamped or
medication not activated
O2 4 liters per nasal cannula
ID band
Equipment available in room:
Incentive Spirometer
IV start kit
IV tubing
IV pump
O2 delivery device
Other Props:
Medications and Fluids:
IV Fluids
IVPB
Diagnostics Available:
X-Rays (Images)
Documentation Forms:
Admit Orders
Physician Orders
Flow Sheet
MAR
Recommended Mode for Simulation
Programmed
Manikin to be used ANY Manikin # 1
Significant Lab Values
Physician Orders D51/2NS at 125ml/hr
Rocephin 1 Gm IV Q 12 hours
Oxygen 4 L/NP
Bedrest with BRP, SCDs when in bed
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
3
SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Progression Outline
Stage 1
Initial Amount
Time in Initial
Stage- 5 mins
Baseline Vital
Signs
T PR 37.4, 88, 24
BP 146/88
SPO2 92% on 4L
NP
Cardiac Rhythm
SR
Breath Sounds
Course crackles in
lower fields with
decreased breath
sound left lower
lobe.
Heart Sounds WNL
Abdominal Sounds
WNL
Other Symptoms:
Eyes open
Trending:
VS ↑ or↓ over time
Verbalization
(Pt/Manikin
Cues)
“Boy, you
nurses are
really busy all
the time! I
don’t know
how you keep it
all straight.”
“I didn’t want
to bother you
during the
night, but my
IV has been
bothering me
for a few hours.
It’s becoming
more
uncomfortable.”
Expected
Interventions
Primary nurse
identified
wrong IV fluid
hanging on
patient and
infiltrated IV.
Alternate or Incorrect
Treatment Choice
That Will Affect Outcome
Confederate
Actions/Additional
Role Player Cues
IV nurse to restart IV,
if primary nurse has not
identified IV error, IV
nurse to point out that
the label doesn’t match
the patient wrist band.
Communicates
with night
nurse about
error. (Using
CUS format)
Calls for IV
nurse to restart
IV
Calls MD to
report error
using SBAR
IV nurse uses
AIDET as
introduction to
patient
IV nurse to
restarts IV.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
4
SIMULATION DESIGN & PLANNING TEMPLATE
Instructor Check List
(return to CHESC assistant at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
6.
7.
8.
Equipment is staged as requested.
The learner has been oriented to the simulator.
The learner understands the guidelines/expectations for the
scenario.
Participants understand their assigned roles.
The time frame Expectations for simulation met: Yes No.
The time frame Expectations for debrief met:
Yes
No.
Audio/Visual Consent signed and turned into CHESC sheet.
Attendance sheet completed and given to CHESC staff.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
CHESC Assistant Name:
Did the person provide excellent support for the scenario?
Yes
No Comment
Instructor signature ________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
5
SIMULATION DESIGN & PLANNING TEMPLATE
Participant Check List
(return to Instructor at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
I have been oriented to the simulator.
I understand the guidelines/expectations for the scenario.
I understand the assigned role.
My questions about the simulation have been answered.
I have all necessary equipment for the simulation.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Participant Signature ____________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
6
SIMULATION DESIGN & PLANNING TEMPLATE
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Optional Literature References
Hughes, R. G., (Eds.). (2008). Patient safety and quality: An evidence-based handbook for nurses.
Rockville, MD: Agency for Healthcare Research and Quality.
The Joint Commission. (2013). National patient safety goals effective January 1, 2013. Retrieved
from http://www.jointcommission.org/assets/1/18/NPSG_Chapter_Jan2013_HAP.pdf
Institute for Healthcare Improvement. (2013). SBAR technique for communication: A situational
briefing model. Retrieved from
http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefin
gModel.aspx
Debriefing Guidelines
(Remember to identify important concepts or curricular threads that are specific to your
program)
1. Leave the simulation room and go to a conference room, if possible. It allows for deescalation of emotions.
2. Solicit and validate emotions briefly. Validate simisms (the simulation isn’t 100% accurate
due to different equipment, personnel etc)
3. What went WELL in this simulation?
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
7
SIMULATION DESIGN & PLANNING TEMPLATE
4. What DID NOT go well in this simulation?
5. If you could do it again, what would you do differently?
6. Summarize:
“What I hear you saying is . . .”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
8
SIMULATION DESIGN & PLANNING TEMPLATE
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
9
SIMULATION DESIGN & PLANNING TEMPLATE
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
10
SIMULATION DESIGN & PLANNING TEMPLATE
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
11
SIMULATION DESIGN & PLANNING TEMPLATE
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
12
SIMULATION DESIGN & PLANNING TEMPLATE
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
13